IS the health secretary Humza Yousaf personally responsible for the existential crisis in the NHS?

I don’t see it.

Holyrood’s opposition parties are clamouring for his head, but I can’t find it in me to pin the blame solely on him for the diabolical waiting times or ambulances queuing to offload their fragile cargo while 999 calls mount up. 

He over-promised, with his doomed pledge to end waits of more than two years by the end of September 2022; he and his government colleagues also stand accused of being divorced from the reality of life in the NHS. But he’s also the blighter who was left holding the toughest brief in government when the music stopped. Will getting rid of him solve the delays and overcrowding? I’d like to hear how.

Covid staff burnout and delayed treatments are by no means the only reasons for the current mess, as Scottish ministers would have us believe, but it’s ludicrous to pretend that Yousaf can simply make different decisions and the waiting lists will melt away. These are problems with deep roots.

Decisions made in the Scottish Government have contributed to this awful mess, but they go back many years. The Scottish Government has been great at setting targets, much less good at making the NHS sustainable. If you’re looking for someone to blame in cabinet, the person at the head of the table probably bears a greater responsibility. The Conservative government in Westminster bears a greater share still for its parsimony since 2010 and, of course, Brexit which is shrinking the economy and has led to valued EU staff leaving the NHS.

But blame doesn’t solve complex challenges. An honest appraisal of the problem would help, but where the Tories and the SNP align is in their painful reluctance to face the truth, which is that we need to raise more in tax for the NHS if we want it to survive.

It truly is about survival. What we are witnessing amounts to the wasting away of Britain’s proudest institution, now apparently in its end stages. It began many years ago and relates to a persistent political failure to tackle the huge funding gap that was developing between what we were paying for the NHS and the growing demands we were placing on it.

We knew the population was ageing and that treatment options were increasing, but imagined we could somehow keep the ship afloat on staff goodwill and passing the burden to an understaffed, unprepared community care system, in place of higher taxation, better wages and better workforce planning.

We were wrong.

This is a tough discussion in a cost-of-living crisis, and the tax burden must fall on those who can afford it, but the cash must come from somewhere. Scottish ministers can surely see that, so should be putting it right at the heart of their referendum case: vote for independence and you’ll have a properly tax-funded NHS. It might just win them some support.

It can’t just be about cash – reform is urgently needed too. Not “reform” Thatcher-style, meaning creeping privatisation, but making better use of digital technologies, integrating health and social care more effectively and changing the way primary care is delivered.

But we need realistic levels of taxation, not just because the NHS needs it but because without it, other services like education, social work and policing will face more cuts as the NHS sucks cash away from them.

The SNP makes no mention of the NHS in the three independence discussion papers it has published to date, but its economic case for independence implies a difficult financial environment post-independence. Scotland is currently used to higher spending per head than elsewhere in the UK with a slightly lower tax take, excluding oil. The paper commits to limits on borrowing for day-to-day spending, but as the Institute of Fiscal Studies points out, says nothing about what this would mean for Scottish taxes or public spending. Well, we need to know.

We will hear from the Scottish Government in due course about its plans for the NHS post-independence, but if it pretends that a fully funded NHS can be provided Truss-style without tax rises, through rapidly growing the economy, then its credibility will collapse.

Of course no one wants to pay more tax but when doctors and hospital managers are openly discussing having those with the means pay for operations because the system is broken, then there are no better options left. One way or another, the same people will be paying more for the NHS in future; the question is whether or not they do it in a way that at least tries to preserve its founding principles. The choice is between a two-tier system, where the wealthier pay but get better access to care, or higher taxation (mainly on the wealthy) that maintains universal care free at the point of delivery.

We want the NHS to survive. Polls show that while the country becomes increasingly agnostic, the halo around those three blue letters burns brighter than ever. No wonder, because it’s extraordinary.  It is so much more than a public service; it occupies a folkloric status in the British psyche, revered like a deity.

The NHS is the young doctor who attended my mother in the early hours of Sunday morning, bringing with him a reassuring, professional manner and performing a thorough examination that took as long as it took. 

The NHS is the consultant who saw my husband on Tuesday and spent an hour with him, performing a procedure and ensuring all his questions were answered. Both patients are full of heartfelt gratitude – I’d even call it love – for this creaking, very British institution and the care they have received at the eye of the storm. There aren’t many beacons of justice in this world made by human hands. What an abject failure it would be to let this one die.

Brexit has swung the pendulum of public opinion towards independence but it could turn out to be people’s love of the NHS that determines which way they vote on independence. A credible plan for a properly funded health service in an independent Scotland? Now that would be a cause worth voting for.

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